Kidney Disease In Dogs & Cats, Using Calcitriol

Canine Kidney Disease & Feline Kidney Disease
Kidney disease affects about 1/3 of our pets. In previous Caring for Pet blog entries we covered the difference between kidney disease and kidney failure, signs a pet has kidney disease, causes of kidney disease. We covered treatments, including holistic therapies and conventional medications. Now, let’s discuss Calcitriol, a new conventional medication used for cats & dogs with kidney disease.

Role of Calcitriol
Calcitriol helps prevent calcium from increasing in the blood. High calcium levels shorten pets’ lives because organs stop functioning when their cells are full of gritty calcium deposits. To make it worse, pets with high calcium levels are uncomfortable.

Signs of High Levels of Calcium in the Blood or Hypercalcemia
Calcitriol is a drug given to pets with kidney disease to help prevent calcium from increasing in the blood to levels that make pets sick. Dogs & cats with high calcium may have these symptoms:
• anorexia
• lethargy
• vomiting & stomach upset
• increased drinking and urination ( polyuria/polydipsia)
• bladder stones (calcium oxylates)
• strange behaviour (neurologic signs).

Other Causes of Hypercalcemia–Cancer
Cats and dogs with cancer of skin, lymph nodes, bones and bone marrow (lymphosarcomas, squamous cell carcinomas, leukemias, multiple myeloma, osteosarcoma, fibrosarcoma, sarcoma, and bronchogenic carcinoma) can also have increased calcium and these pets would benefit from treatment for cancer but not from calcitriol.

Deciding Whether or Not to Use Calcitrol
The first step in using calcitriol is to confirm the pet’s elevated calcium is from kidney disease. The second step is to prevent phosperous from increasing through diet and aluminum hydroxide (covered in previous Caring for Pets discussion).

Deciding How Much Calcitriol to Give, and When to Give Calcitriol
We look at the blood to decide how much calcitriol to give. If serum creatinine is higher than normal (>3 mg/dl) but phosphorus is controlled (<6 mg/dl) calcitriol is started at 3.5 ng/kg/day. The best time to give calcitriol is at bedtime on an empty stomach. This is especially true for pets on high doses. For pets on low doses of calcitriol, the drug can be given with food in the morning. Calcitriol can be given every day, and this schedule is best for those of us with poor memories who can remember to give the same medication every day. However, the safest way to give calcitrion is to give ½ the week’s dose th twice a week, such as Wednesday night and Sunday morning.

Blood Tests Required to Prevent Calcitrol From Causing Harm
Calcitriol can help pets with kidney disease, but it can also cause harm because it affects the amount of calcium in the blood. Blood tests measuring calcium help us adjust the dose so that the potential for harm is minimized. Blood tests are done one week, two weeks and six months after starting the medication.

For pets that have had kidney disease long enough that the parathyroid gland was affected, blood tests to measure parathyroid hormone (PTH) should be done in addition to tests measuring calcium. If the pet is responding to calcitriol as hoped, parathyroid hormone (PTH) will be in the normal range. If PTH is elevated, the pet can have increased dose of calcitriol (1-2 ng/kg increase). If your pet needs a dose of calcitriol that is 6.6 ng/kg/day or higher, then it needs blood tests that measure both total calcium and ionized calcium. Pets on these high doses of calcitriol also need to be off the daily dosage schedule and on the twice a week schedule (3.5 times the daily dose).

What Will You See if Your Pet Benefits from Calcitriol?
How will your pet benefit from calcitriol? You should see improved appetite, more energy, and slowing of the kidney disease. Blood tests with BUN and creatinine livels should hold steady. Urine specific gravity should hold steady. Amount of protein lost in the urine should improve or hold steady.

My Recommendations for Pets With Kidney Disease
Do I recommend Calcitriol for all pets with kidney disease? NO. Whether you have a dog with kidney disease or a cat with kidney disease, always start with supplements and herbs that benefit without causing harm. Then, consider drugs. My recommendations are:
• Omega 3 fatty acids from either fish (Nordic Naturals) or ground flax (Missing Link)
• Herbal fromulas with Rehmannia such as Rehmannia Eight ( Ba Wei Di Huang Wan)
• Home cooked diet or raw diet that controls phosphorus by decreasing organ meats and high phosphorus foods, yet maintains healthy protein levels
• Acupuncture (BL 23, K 3, K 7, ST 36)
• Injectable Vitamin B 12
• Subcutaneous fluids

After doing all these, consider medications: aluminum hydroxide, potassium, calcitriol.

Kidney Disease Isn’t A Death Sentence
Dogs & cats with kidney disease can live long happy lives with our help. Do not despair when your vet says your pet has kidney disease, instead get help from a holistic veterinarian. Every pet can benefit from these suggestions so that it continues to have a life with joy and comfort.